What Triggers Loss of Health Insurance Among the Near-Elderly?

A growing body of work shows that adults who arrive at Medicare eligibility uninsured have greater unmet needs for medical care than those who are continuously insured (Card et al. 2004; Dor et al. 2006; Polsky et al. 2006). The uninsured face significant financial risks as well; for the near-elderly who have a retirement nest egg to protect, the consequences of bad health during an uninsured spell are potentially catastrophic. In order to shed light on why some households are exposed to these risks, I plan to use detailed longitudinal data from the Health and Retirement Study and from the Medical Expenditure Panel Study to analyze the dynamics of health insurance loss among the near-elderly. My specific aims are to answer the following questions: (1) What events trigger loss of insurance coverage among the near-elderly? (2) How do spells without insurance end for the near-elderly? Because most insurance coverage is obtained through a job or a spouse’s job, retirement, job loss, divorce and widowhood are all potential triggers for losing insurance. Spells of illness may also trigger loss of insurance either directly or because illness makes work impossible and employer-sponsored coverage is lost. My research will determine how often health insurance loss or gain can be linked to one or more of these events.